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Personality disorders category is likely to be dramatically revised for next psychiatry textbook

Personality disorders will be trimmed from 10 to six in DSM-5, according… (Wes Bausmith / Los Angeles…)

Several types of personality disorders will be dropped from the next edition of the Diagnostic and Statistical Manual of Mental Disorders. But one disorder previously proposed for elimination -- narcissistic personality disorder -- will likely remain in the text.

The American Psychiatric Assn. announced Thursday that the framework for personality disorders in DSM-5 will be a "hybrid" model that is substantially different from how personality disorders are diagnosed currently. Under the new system, personality disorders will be aligned with particular personality traits and levels of impairment.

The committee working on the personality disorders chapter of the DSM-5, which is due to be published in 2013, has proposed six types of disorders: antisocial, avoidant, borderline, narcissistic, obsessive/compulsive and schizotypal. They have proposed dropping paranoid, histrionic, schizoid and dependent personality disorders.

However, to qualify for a diagnosis, a patient would have to have a high level of impairment in two areas of personality functioning -- self and interpersonal. Patients would be assessed for how they view themselves and how they pursue their goals in life, for example, as well as how they get along with other people and whether they think about the consequences of their actions. The new model is less rigid than the existing diagnostic model. It is designed to reflect that behavior can change over time while personality traits tend to remain stable.

"In the past, we viewed personality disorders as binary. You either had one or you didn't," said Dr. Andrew Skodol, chairman of the DSM work group on personality disorders, in a news release. "But now we understand that personality pathology is a matter of degree."

The American Psychiatric Assn. also announced that a public comment period on DSM-5 proposals has been extended through July 15.